This practice is rated as Good overall. (Previous inspection 04/2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Sashi Shashikanth on 24 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it. A minority of patients reported delays in accessing an appointment with their preferred GP and the punctuality of appointments.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider should make improvements are:

• Ensure all staff are aware of who the practice leads are for key areas of the service.
• Continue to review ways to improve uptake rates for cervical and bowel cancer screening, and childhood immunisations.
• Continue to evaluate patient satisfaction with the availability and punctuality of appointments.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at ‘Dr Sashi Shashikanth’, also known as West London Medical Centre, on 7 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services to the six population groups we inspect - People whose circumstances may make them vulnerable; Older people; People with long-term conditions; Families, children and young people; Working age people (including those recently retired and students); and People experiencing poor mental health (including dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles.
• There was a good skill mix amongst doctors and nursing staff with some clinicians having specialised areas of expertise.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Most patients said they found it easy to make an appointment. Urgent appointments were available the same day but may not be with a GP of the patient’s choice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• A patient participation group had been formed and consulted with during 2014, however the practice had not communicated with the group this year.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure availability of an automated external defibrillator (AED) or undertake a formal risk assessment if a decision is made to not have an AED on-site.
• Encourage the patient participation group to meet again so they can actively contribute to the continuous improvement of the service.
• Ensure staff are familiar with the practice’s vision and values.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr Sashi Shashikanth, also known as West London Medical Centre, provides GP led primary care services to 4,249 patients living in the surrounding areas of Hillingdon and Uxbridge.

We carried out an announced inspection on 28 August 2014. As part of the inspection process we contacted key stakeholders including Hillingdon Clinical Commissioning Group (CCG) and Healthwatch Hillingdon, and reviewed the information they shared with us. During our inspection we spoke with patients, members of the patient participation group, and practice staff. Most patients told us they were happy with the service and spoke positively about emergency appointments and telephone consultations. Some patients were dissatisfied with the length of time it took to receive a non-urgent appointment. Staff told us they were supported in their role and enjoyed working at the practice.

Many aspects of the service were safe but some areas required improvement. Some GPs had not received the required level of training for child protection. The practice was visibly clean, however arrangements for cleanliness and infection prevention and control were not robustly monitored. We also found that staff who required Disclosure and Barring Service (DBS) checks based on their roles and responsibilities had not received these. However, systems were in place to ensure clinical staff were supported and provided with information required to deliver safe clinical care. All staff were aware of safeguarding and how to escalate concerns, and the practice had policies and procedures to monitor safety and respond to risk.

Many aspects of the service were effective but some areas required improvement. Clinicians were aware of their responsibilities under the Mental Capacity Act (2005) and the circumstances in which mental capacity assessment may be required. The practice received multidisciplinary support from a variety of health care professionals. The practice was proactive in health promotion, and ran a nationally recognised weekly ‘healthy walk’ activity for patients. The practice was participating in audits to monitor and improve the quality of care but could not yet demonstrate completed audit cycles. Some clinical staff did not always document that verbal consent to treatment had been obtained. There were also no formal systems to monitor staff training.

The practice provided a caring service. Patients were treated with dignity and respect. Staff were aware of consent and confidentiality procedures. The practice identified the needs of different groups of patients and referred them to support services when required.

The practice provided a responsive service. Patients’ needs were understood and influenced the care delivered. The practice was accessible to patients with mobility needs, and there were systems in place to assist patients who have a hearing impairment and patients who do not speak English. The practice offered extended hours on certain days when patients could see a GP or nurse. The practice reviewed and responded to complaints, however they lacked a formal system for documenting their actions and learning achieved.

Many aspects of the service were well-managed. There was strong leadership from the GP principal, who had the dual role of GP principal and practice manager. Governance arrangements were in place with identified leads for specific areas of the service. The practice sought the views of patients via surveys and the patient participation group, and made changes in response. The practice could do more to ensure practice meetings were formally scheduled and documented. The practice also needed to update its policies and procedures, and ensure staff reviewed these.

The provider was in breach of regulations related to:

• Cleanliness and infection control
• Records
• Requirements relating to workers
• Supporting workers

The majority of patients registered at the practice were above the age of 65, and the annual flu campaign was aimed at these patients. Multidisciplinary input was received for patients with complex health needs, and patients were signposted to emotional support services.

The practice were knowledgeable about the health needs of patients with long term conditions, and encouraged patients with conditions such as asthma, chronic obstructive pulmonary disease, diabetes, and coronary heart disease to attend the practice for reviewing and monitoring.

The practice offered a baby clinic for the six-week baby check, immunisations and mother’s post natal care. GPs met with the health visitor every two months. Children’s immunisation history was checked during registration with the practice and immunisations were offered.

The practice offered extended opening hours, telephone consultations and email correspondence to meet the needs of working age people and those recently retired. New patient health checks were performed during registration with the practice, and patients aged 40-74 were offered the NHS health check.

All patients with learning disabilities had received their annual health check. Carers needs were identified and support was provided. Staff had received vulnerable adults training and were aware of how to escalate concerns.

The practice supported patients experiencing poor mental health and were able to refer to different community services to meet the needs of the patient. GPs had good knowledge of mental capacity and were aware of when they may need to assess this.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.